[The minimally invasive Chevron and Akin osteotomy (MICA)]

Abstract

Objective: Percutaneous correction of a hallux valgus deformity with or without transfer metatarsalgia.

Indications: Hallux valgus deformity up to 20° intermetatarsal angle, without instability of the first tarsometatarsal joint.

Contraindications: Symptomatic arthritis of the first metatarsophalangeal joint, as well as instability of the first tarsometatarsal joint.

Surgical technique: Percutaneous performed osteotomy of the distal metatarsal 1 in combination with a medial closing wedge osteotomy of the proximal phalanx of the first toe.

Postoperative management: The use of a postoperative shoe with a rigid sole allows adapted weight bearing in the first 6 weeks. Active and passive mobilization can start immediately after surgery.

Results: The method is very effective to treat even severe deformities with or without metatarsalgia. The amount of correction is similar to open procedures. We recommend cadaver training to become familiar with this technique. Thus, complications such as nerve, vessel or tendon injuries can be avoided. The intraoperative radiation exposure remains significantly elevated even for experienced surgeons. In addition to the aesthetic benefits, there is less soft tissue traumatization compared to conventional open procedures. There is no need of bloodlessness. The minimally invasive Chevron and Akin osteotomy is a safe and powerful technique for the treatment of hallux valgus deformity.

Keywords: Bunion; Forefoot; Metatarsalgia; Osteotomy; Percutaneous.